Ethics of Organ Donation

April 25, 2013
nuffieldorgan

Activities to teach about the ethics of donation of bodies for medicine and research are the latest resources developed by the Education Advisory Group

It’s about 18 months since the release of the Nuffield Council on Bioethics reports on the donation of human bodies for medicine and research. In the intervening period the Council’s Secretariat and Education Advisory Group (of which I am a member) have been refining a series of resources for teaching about the ethics of human tissue usage.

On this occasion the resources have been targeted primarily for students at KS4 (GCSE).  The materials have, however, been provided in both PDF and Word formats precisely to allow for adaptation should anyone wish to use them in a slightly different context. Issues covered include: terminology, altruistic donation, prioritisation of different uses of human tissue, and an intervention ladder to determine how best to increase the shortfall in available organs in an ethically-appropriate way.


Headline Bioethics: Change to organ donation law in Wales?

January 9, 2013

[A printable version of this Headline Bioethics Commentary is available via this link]

OptOutMediumAuthor: Christopher Jones

Clip: Will Wales change organ donation law?

Date of story: 8th November 2011

Summary of story: The Welsh government’s has published a White Paper Proposals for Legislation on Organ and Tissue Donation: A Welsh Government White Paper in which they outline their intention to change the law regarding organ donation. In keeping with the rest of the UK, Wales current has an “opt-in” system, in which a person has to actively indicate (e.g. by signing organ donor register) that they give consent for their organs to be used by the NHS. Under the proposed system of presumed consent, all adults resident in Wales will automatically be placed upon the register; if anyone wishes to withdraw their consent they must actively remove themselves from the list. Many countries already operate this “opt-out” system; including, in Europe, such countries as France, Spain, Austria, Belgium, Norway and Sweden. In the news coverage, Glyn Davies MP state his opposition to the proposal, highlighting concerns about both the efficacy of the new system, and whether adequate consideration will be given to ethical aspects of the change.

Discussion of ethical issues: One ethical argument against presumed consent suggests that it violates the patient’s right to make an informed decision, and so does not uphold respect for their autonomy (Gillon, 1994). The specific purpose of informed consent is to protect a patient’s right to autonomy, as made clear by both the Universal Declaration on Bioethics and Human Rights (UNESCO, 2005) and the Declaration of Helsinki (World Medical Association, 2008). Enforcing presumed consent would remove the need for informed consent, and as such would be “a violation of an individual’s autonomy” (Kurosu, 2008).  Presumed consent, it is argued, forces patients either to become donors, or to state their wish to not become donors; in both instances the patient’s autonomy is violated, as  “compelling patients is unethical” (Kurosu, 2008). This deontological argument suggests a move to presume consent in Wales would be intrinsically unethical. Similarly, Kennedy et al. (1998) consider that a government body “assuming possession of our body parts” would be “a step too far”. Read the rest of this entry »


Headline Bioethics: Too NICE to Push? Ethical issues surrounding a woman’s decision for elective caesarean section

January 7, 2013

[A printable version of this Headline Bioethics Commentary is available via this link]

Author: Matthew Taylor

Clip: Women can choose caesarean birth

Date of story: 23rd November 2011

Summary of story: In November 2011, The National Institute of Health and Clinical Excellence (NICE) updated its clinical guidance to health care professionals regarding caesarean sections. This update helps ensure “every mum-to-be in England and Wales can request [a caesarean birth].” The story examines the case of Leigh East, who had concerns over a vaginal birth due to a pre-existing back injury. She was initially refused a caesarean section (CS), but was allowed the treatment after her own research persuaded her midwife to allow it. East said, “There was a great deal of pressure initially to not plan a caesarean”.

The report continues by covering how women who have had a traumatic experience with natural childbirth in the past should be treated. This includes offering counselling and, ultimately, the option for a caesarean birth if the woman is not reassured. Jenny Clery, Head of Midwifery at Whittington Hospital, said “you shouldn’t force anything on anybody, i.e. go into labour and we’ll see what happens.” The report finishes by stating the new guidelines are there to help women make an inform decision regarding mode of birth (BBC, 2011a).

Discussion of ethical issues: There are many ethical issues surrounding a woman’s choice regarding the mechanism of delivery for her unborn child. Doctors are faced with decisions requiring them to take each case individually, taking a consequentialist approach to each mode of birth, whilst also considering patient autonomy. The Changing Childbirth report (Expert Maternity Group & Cumberlege J., 1993) makes it an explicit right for a woman to be involved in decisions regarding all aspects of her pregnancy and childbirth. Read the rest of this entry »


Bioethics videos: Class of 2011

June 13, 2011

For the past few years, Second year Medical Biochemistry students at the University of Leicester (and Medics taking the relevant module as a special studies course) have been asked to produce short videos on a bioethical topic. It seemed a shame not to make their excellent videos more widely available, so we’ve started to post some to YouTube. Topics covered this time around included: organ trading, egg donation, brain imaging and public health initiatives.

The team looking at the ethics of organ trading based their video around a woman seeking a privately-organised transplant for her daughter. This issue is highly topical at the moment, with the recent publication of Scott Carney’s book The Red Market: On the Trail of the World’s Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers.

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Read the rest of this entry »


Fighting Talk (Doctors) – a duty to disclose?

July 24, 2008

(Warning: contains plot spoilers!) This is an old episode of the BBC’s daytime drama Doctors, centred on the Mill Health Centre, a fictional midlands clinic. The relevance is probably limited to clinical ethics training for medical students, but it’s great for that purpose so worthy of a quick note here.

In Fighting Talk (TRILT ID: 0059FD65, first broadcast on BBC1, 15th June 2006), Dr Greg Robinson is faced with a dilemma when local bully Darren Waters has beaten up geeky pupil Kevin Dobson on his way to school. What Darren doesn’t realise is that Kevin is HIV positive. When Darren presents at the clinic with a bleeding hand and then Kevin later comes in with cuts to his face, Dr Robinson realises there is a risk that the virus has been transferred from victim to bully. Does he have a duty to disclose the details to Darren and his family?

In truth, the episode is entirely focussed on this story, punctuated with snippets of longer term issues for those who work at the Mill Health Centre. One short section, however, conveys all that needs to be told as a case study for tutorial group discussion. In the section starting at 16:23 Dr Robinson visits Kevin and his mother trying to persuade them to let him tell Darren. Kevin’s HIV status is mentioned openly, it had only been hinted at in early clips. The scene runs onto 19:17, but is best stopped at 17:50 when Kevin’s mum puts her hand on his shoulder – the rest of the clip is window dressing.

For completeness, the clips in which the story unfolds are: 02:00-02:58 (the fight), 03:40-05:03 (mum patches Kevin up), 07:52-10:00 (bully goes to GP), 10:26-12:40 (Kevin goes to GP), 12:40-13:37 (Dr Robinson discusses what to do with colleague), 14:10-15:55 (Doctor visits Dobson family), 16:23-19:17 (HIV status discussed), 20:11-20:50 (Doctors discuss ethical duty), 20:50-21:10 (Kevin visits clinic to give consent), 21:37-23:38 (Dr Robinson tries to get Kevin’s mum to agree), 24:22-26:12 (Kevin persuades his mum).


WIT: A window on tensions in clinical trials

June 12, 2008

(Warning: contains plot spoilers!) Adapted from Margaret Edson’s 1999 Pulitzer Prize winning play, Wit tells the tragic story of Professor Vivian Bearing (Emma Thompson). Vivian, a ruthless scholar of 17th Century English poetry, is diagnosed with advanced stage 4 metastatic ovarian cancer. Dr Harvey Kelekian (Christopher Lloyd), Vivian’s consultant physician and leading figure in this area of medical research, explains that the most effective treatment option she has is an aggressive experimental chemotherapy at the full dose.

Professor Vivian Bearing

 
Professor Vivian Bearing (Emma Thompson)  

She cautiously consents to the therapy and embarks on a degrading regime of eight cycles, which no other patient has completed before. With a fearless determination, Vivian does everything the doctors ask of her, and as such illustrates the central ethical issue observed in this film; the conflict of interest witnessed between clinical therapy and clinical research. Throughout, this is entangled with clinical incompetence, issues of informed consent, end of life decisions and Vivian’s frustration with the hospitals insensitive mechanistic approach to their patients, having been asked repeatedly “How are you feeling today?” (00:04:10 – 00:05:25) Read the rest of this entry »